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Passport Name *

Gender *

Date of birth(dd/mm/yy) *
Email *
Cell phone *
SNS Account *

Surgery History *

Please include Surgical History and Allergy (be as specific as possible). *
Date of Surgery(dd/mm/yy) *

Promotion Info

BoCelle Aesthetic Medical Group
Bocelle Liposhot
¥1,622 ¥3,243

Final Settlement Info

Price
3,243
Discout price
1,622
VATPrice
0 USD

The amount due
1,622